No matter what you call out-of-control sexual behavior, whether it is sex addiction, porn addiction, hypersexuality, compulsive sexual behavior, problematic sexual behavior, unhealthy sexual behavior, or any other term, people struggle with their sexual behavior and often seek me out to help them with their issues and concerns.

Recently I had a group consultation with Douglas Braun-Harvey, co-author of a new book Treating Out of Control Sexual Behavior: Rethinking Sex Addiction and many of my fellow colleagues in Austin, TX who work with people who struggle with their sexual behavior.  Doug is a sexual health author, trainer and psychotherapist based out of San Diego, CA and focuses on sexual health as the primary principles in treating people who identify as having out-of-control sexual behavior.

While the book is new, the work is something that I have been using in my practice for years and it is so nice and refreshing to see authors and therapists publish very important and valuable work in the treatment of out-of-control sexual behavior.

While I would recommend reading the book, in short, Braun-Harvey and Vigorito’s works defines out of control sexual behavior as a “sexual health problem in which an individual’s consensual sexual urges, thoughts, and behaviors feel out of control (to them)” as opposed to a mental illness”.  The treatment for out of control sexual behavior focuses on creating goals in treatment that align with the following 6 principles of sexual health: consensual; non-exploitive; free from STI’s, HIV, and unwanted pregnancy; honesty (secrecy vs. privacy); shared values; and mutual pleasure.

If this definition and treatment model feel right for you, give me a call and we can get started in getting you on the path of sexual health and wellness and more in control over your sexual behavior.

Take a listen at my latest online appearance on Carol the Coach, an online podcast available on iTunes that is dedicated to helping those with compulsive sexual behavior and sex addiction and the clinicians who work within the field.

Like what you hear?  Want to hear more?

Is it cheating or sex addiction? I get this question a lot, often from spouses who have been betrayed and are trying to understand their partner’s behaviors. It’s a complex question, with an even more complex answer. The diagnosis of a sex addiction is controversial both in the field of sex therapy and mental health therapy, as well as in pop culture and mainstream opinion. There’s no doubt in my mind that sex addiction exists, and sometimes I find it interesting that people are so adamant about insisting that it does not exist. Sometimes I wonder if those who insist that it doesn’t exist have ever struggled with sex and love addiction or have ever worked with clients that have struggled with sex and love addiction. It isn’t my style to debate controversial issues on my blog or  in public forums, so I’m just going to present my views on this topic based on my experience, training, and knowledge.

Cheating
As complex as this question is, so are the two types of behaviors that we are discussing. “Cheating” can be defined in a million different ways  and is often highly individualized and based on what the individuals and the couple constructs as the boundaries of their relationships.  These boundaries can be affected by many socio-cultural factors such as culture, ethnicity, geography, religion, age, generation, time period, gender, sexual orientation, social group, and on and on.

For the purpose of this article I will just simply define cheating as having relationships, either sexual, emotional, or both, outside a committed relationship where monogamy and exclusivity is either implied or explicitly expected. This is important because often times people will insist that it wasn’t “cheating”, because they were on a break, or they were just starting to date. But if exclusivity was implied at any point during the time in question, either verbally, nonverbally, physically, or non-physically, then it likely could still be considered cheating.  Another question I always ask is “Did it feel like cheating?” Even if something falls in the gray area of cheating or not, if it feels like cheating, it likely should be treated like cheating.

Another important thing to note is that different relationships define “cheating” differently. It would be important to determine what the relationship considers cheating before assigning someone the label as a “cheater”. For example, does the relationship consider watching pornography cheating? Does the relationship consider going to an adult film store and watching a private movie cheating? Does the relationship consider going to a strip club cheating? What about sensual massages (happy endings)?  Prostitutes?

Photo by Todd Huffman

While in most relationships cheating is often defined as being sexual with other people, there’s a lot of gray area in defining what cheating is and is not.

Sex Addiction
There are many definitions of what a “sex addiction” is and generally the definitions involve some problematic sexual behaviors with an inability/unwillingness to stop despite consequences.  While people commonly use the term “sex addiction”, I usually like to allow my clients to define for themselves when we discuss the issues.  I often use “compulsive sexual behavior”, “problematic sexual behavior”, “unhealthy sexual behavior”, etc. as ways to describe behaviors that my clients present with.  Not all problematic sexual behavior falls into the definition of addiction, but the treatment is often similar.   However I’m not afraid to call a spade a spade and if it walks like a duck, looks like a duck, and quacks like a duck, then sometimes I will just tell the client it is a duck.

What I don’t encourage is having other people make that diagnosis for the client.  Often times another therapist, a spouse, a partner, family, and friends will assign the client a diagnosis in efforts to understand the behavior. A diagnosis should be a collaborative decision, between a qualified professional who has experience diagnosis and working with clients with sex and love addiction and the client and, if appropriate, the partner.  The goal of a diagnosis or label is to help the client gain awareness and understanding and eventually healing from the issues they are struggling with.  I often cringe at the word “diagnosis” as I sometimes feel that diagnosing or labeling a client is sometimes counterproductive, but many times offering a label or diagnosis can get the client started on a path to recovery through resources, meetings, groups, and other things that have an immense therapeutic value.

Diagnoses or labels should not be used for the purpose of understanding someone’s behavior, to make excuses for that person, or blame that person or something beside that persons for what is happening.   I sometimes see partners of those who had cheated or who have a sex addiction looking for a label as a way to understand their partner’s behaviors. For example, it is not uncommon for a partner to want to label their partner as a cheater rather than a sex addict because the label of a sex addict seems so much more negative or severe than a cheater. On the other hand, some partners want the diagnosis of a sex addiction because it’s easier to understand it as a disease rather than a choice.    A diagnosis and/or label of sex addiction or cheating should be one that is collaboratively made between a client and their therapist and can  involve the partner as long as it is appropriate to include the partner in this process.  A time when including the partner in the diagnosis would be contraindicated is when the partner attempts to skew the diagnosis for their own understanding or if the partner is more concerned about their needs for a certain diagnosis than for the needs of the client who is attempting to receive treatment for their behavior.  This is a fine and delicate line and should not be addressed without the consultation of a qualified professional who specializes in infidelity, affairs, cheating, and sex addiction.

Photo by h.koppdelaney

Denial and Compartmentalizing
Denial and compartmentalizing are back-up dancers to the leads of sex addiction and cheating.  Without denial or compartmentalizing behaviors, neither cheating or sex addiction would be able to exist in the context of problematic sexual behavior.  Very rarely do I see cheating and sex addiction without some form of denial and compartmentalizing of behavior.  While denial is defined as not facing a fact because it is too uncomfortable to accept, compartmentalizing is an unconscious (or conscious) psychological defense mechanism used to avoid the discomfort of anxiety and discomfort caused by conflicting values, behaviors, thoughts, and actions.  Both run rampant in these situations and are often part of the first stage of treatment for sex addiction and cheating.

Is it cheating or sex addiction? No Internet resources would truly be able to point you in a  definitive answer. You should consult with a qualified sex therapist for sex addiction therapist before trying to self diagnose. I’d be happy to help you with this. Please feel free to call or email me for more information or to set up an appointment.  I can be reached at rhiannon[at]sextherapy-online.com or 603.770.5099 or 512.765-4741.  Or you can fill out the form below and I will contact you!

There are many famous sex addicts in history that are being “unearthed” through various stories, autobiographies, books, plays, movies, and media.  And even today, a week doesn’t really go by without some sort of high profile person being caught in a compromising position with their sexual behavior (as a sex therapist, EVERYTHING can seem like a pun!).

What I want to know is WHY are sex addicts and those struggling with sexually compulsive behavior still such a taboo and underserved population?  What do the famous sex addicts in history and those with problematic compulsive sexual behavior have to teach us now in the treatment of sex addiction?  What is the implication with how their spouses handle it (there is no manual for partners of sex addicts- so what do these famous people’s lives have to teach us)?

Many of the folks that are considered pioneers in the civil rights movement STRUGGLED with compulsive sexual behavior.  Here are just a few snippets of what went on (based on what I have learned, these are by no means “verified” facts but information that has been presented in a variety of sources).

John F. Kennedy, Jr. had a SEVERE sexual addiction that was well-known and not that well covered up.  It is mostly clear that Jackie was fully aware of this.

Photo by roberthuffstutter

Martin Luther King, Jr. had many sexual partners, as evidenced by the wire tapping tapes that the FBI had on him where he made many arrangements with sexual activities.  (I like this Blog Entitled “How I Choose to Respond to Dr. Martin Luther Kings Likely Sex Addiction”)

Photo by caboindex

Lyndon B. Johnson was said to have a very fragile ego and used sexual activities with other women as a way to handle those emotions.

Photo by Ninian Reid

Three main power figures in the civil rights movement all struggling with a similar situation.  Many would argue it was “just the time”, but the behavior speaks otherwise.

And the list of powerful, famous people struggling with their sexual behavior goes on: Tiger Woods, Eliot Spitzer, Anthony Weiner, Bill Clinton, Michael Douglas, David Duchovny, and others.  Across the pond in the United Kingdom, the royal family and government has been riddled with sex scandals as a result of sexually compulsive behavior.  Most recent there is Brooks Newmark.  In the 1960’s, there was the massive scandal known as the “Profumo Affair” and even reaching farther back in history, Count Leo Tolstoy and James Boswell were well known for their struggles with this issue.   Each has their own story, representing thousands of stories that go untold.  And men in positions of power, high profile men, and those with access to resources are often a common typology of those who tend to act out sexually.

This article is a nice summary of “Why Men in Power Act Out” (the link is to a treatment center webpage, but please do not confuse that I am endorsing this particular center).

And not to forget the women, as actress Vivian Leigh was well known for her sexual behavior and others still emerging in my investigation.

I’d like to dig deeper and understand the historical perspective around famous sex addicts in history and compulsive sexual behavior.  I believe that people have been struggling with this for MANY years and only because those who struggle live in silence and shame do we perceive that this is not “real” or “not on my doorstep”.   But this is real and I’d like to know where the struggle has been to know more about where we are now and where we are going.  Clues to the present and future can lie in the past.

My next blog would like to dissect the partners reactions to their spouses alleged sexual addiction.  I think how the partners chooses to react is very interesting and can help construct all the ways you can handle your spouse revealing (whether voluntary or not) that they have a sex addiction.

If you or your spouse or partner or someone you know is struggling with a sex addiction or compulsive sexual behavior, there is help and hope.  For the residents of Maine, Massachusetts, New Hampshire, New York, and Texas, SexTherapy-Online provides comprehensive online therapeutic services for those struggling with sex addiction and compulsive sexual behavior and their spouses/partners.  Please contact Rhiannon C. Beauregard, MA, LMFT-S, CST at 603.770.5099 or (512) 765-4741 or email her at rhiannon[at]SexTherapy-Online.com for more information.

Finding quality treatment for sex addiction, whether you are the one who identifies as a sex addict or are the partner, spouse, or loved one of one, is a huge challenge.  This is especially true in rural areas, as there are often not readily available resources and therapists that have been trained and are qualified to treat those affected by sex addiction.

There are options, though, for those looking for treatment for sex addiction but are having a hard time finding a therapist that specializes in sex addiction in their area.  I’ll start with how to find a treatment program or therapist close to you, and end with the option of finding someone online that specializes in sex addiction.  SexTherapy-Online (www.sextherapy-online.com) is one such practice that provides quality online sex addiction therapy to clients, partners, and couples.

In-patient or Out-Patient Treatment for Sex Addiction
The first step would be to decide whether the person with the sex addiction wants/needs in-patient or out-patient treatment.  In-patient treatment for sex addiction is treatment that is usually provided at a residential treatment facility, such as a hospital, rehab facility, retreat, etc., that includes a certain length of stay (as short as three days up to 90 days is typical).  In-patient treatment for sex addiction usually requires their patients/clients to live at the facility and may or may not involve returning home on weekends or overnights.  Generally, most people travel to these facilities for sex addiction treatment.

Out-patient treatment for sex addiction can look like a variety of things.  Intensive outpatient treatment programs for sex addiction (often called IOPs) are usually programs that meet during the day, either for a half day or full day, but allow the clients/patients to return home overnight.

The above mentioned treatment options for sexual addiction are considered the most effective and the most intensive and have a good reputation of helping people treat their sex addiction.

Other out-patient treatment options for sex addiction and spouses and partners of sex addicts can look like weekly (or more) therapy with a qualified professional plus 12-step meetings and other therapies.  Out-patient treatment programs can often be tailored based on the clients access to time, resources, and responsibility.

Outpatient Treatment for Sexual Addiction for Addict and Partner
Good out-patient treatment should follow a “three-legged stool” approach (Carnes, 2015).  The first leg of the stool is the addict’s therapist and an appropriate support group and/or 12-step program.   There are several 12-step groups for sex addiction including:

Sexual Compulsive Anonymous: http://www.sca-recovery.org
Sex Addicts Anonymous: https://saa-recovery.org
Sex and Love Addicts Anonymous: http://www.slaafws.org
Sexaholics Anonymous: http://www.sa.org
Sexual Recovery Anonymous: http://www.sexualrecovery.org

The second leg of the stool is the partner’s therapist and an appropriate support group.  Services for partner’s are generally very lacking at this time in the field and most areas do not have a support services for partners; however, there are a few resources available through the following organizations:

Codependents of Sexual Addiction: http://www.cosa-recovery.org
Partners of Sex Addicts Resource Center: http://posarc.com

The final leg of the stool is for the couple to have their own therapist, who may or may not be appropriate to do family work (let’s not forget about the often overlooked victims of sex addiction: the children of sex addicts).

Finding a Therapist for Sex Addiction
Now here is the million dollar question: how do I find an QUALIFIED therapist, intensive outpatient treatment program, or inpatient program that can help someone with sex addiction and their partner, especially in areas where therapist’s might be hard to find (such as rural areas)?

Two places to begin would be the following:

The American Association for Sexuality Educators, Counselors, and Therapists (AASECT) http://www.aasect.org, is the national certifying body for sex therapists.  You can search by state and find a professional who is certified in the field of sex through a rigorous certification process.  Now not all AASECT professionals will have experience or training in sex addiction, so it is important to ask them if they have worked with and have training in sex addiction.  Another important point is that not all therapists have experience with working with each leg of the stool (especially couples) so it is important to make sure that your therapist is skilled and trained to work with couples as well (if the therapist you are seeking is for the couple).

Another place would be the International Institute of Trauma and Addiction Professionals (IITAP) http://www.iitap.com.  This Institute certifies Certified Sex Addiction Therapists (CSAT) and you can search by zip code and by state. These therapists have gone through an intensive four, week-long training module series to have them certified as a CSAT.  As mentioned above, make sure that they have experience working with  addicts, partners, and/or couples before you make your decision.

Another option, since many folks won’t live anywhere close to a Certified Sex Therapist  or a Certified Sex Addiction Therapist, would be to Google “sex addiction therapy” or “sex addiction therapist” or “sex addiction treatment facility” and your state or location.  This will likely pop up anyone close to you in your area that may work in sex addiction or any treatment centers close to you (as likely the search will be done by your location).  On the first page of your search results, you will most likely see a link to a PsychologyToday listing: Psychology Today is the leader in independent therapist listings and will take you to a page of therapists that list one of their specialities as sex addiction.  This is a good list, HOWEVER, BUYER BEWARE!  Most of the folks that list sex addiction as their specialty feel comfortable working in sex addiction but may or may not have any training in the field of sex or sex addiction.  It’s important to read their short biography on Psychology Today, then go to their website from their profile page and read their qualifications.  Psychology Today only verifies that the therapists are licensed in their states (or going to be licensed).  They do not verify that the therapist is actually trained in sex addiction treatment.  Then give them a call and check them out.

SexTherapy-Online: An ONLINE Option for Sex Addiction Treatment
So what happens if you find NO ONE in the above stated methods that is close enough to you to be practical to see them frequently (especially if you choose outpatient therapy for treatment)?  Look for “online sex addiction therapy” and your state and see what you find!

SexTherapy-Online (www.sextherapy-online.com) is an online sex therapy practice that specializes in sex therapy and treatment for sex addiction.  SexTherapy-Online can help clients, partners, and couples struggling with sex addiction from the states of Maine, Massachusetts, New Hampshire, New York, and Texas.  SexTherapy-Online provides therapy over the internet using secure video conferencing, secure online chat, or over the phone.

An important thing to note, though, is that online therapy is usually limited to the state’s that the therapist is licensed in (meaning you most likely cannot receive therapy from a person in California if you live in Maine).  The only exception to this would be if for some reason your state allowed you to receive treatment from a therapist in another state (which is a rarity- most states only allow you to be seen by therapists in the state you are living in or residing in).  You would need to consult your state’s laws before seeking out this type of distance or “tele-therapy”.

Even if the therapist does not offer online or tele-services, don’t be afraid to ask!  They might be willing to see you, especially if you don’t plan on using insurance for treatment, at a distance.  But again, be aware that this might be a modality out of the therapist’s scope so it might not be appropriate for everyone.  Also, an online model for treatment isn’t appropriate for everyone, especially folks with more severe co-existing conditions like chemical dependency, suicidal ideation, bipolar disorder, personality disorders, and a history of violence.

Making Sure Your Therapist is the Right Fit
It is important to call your therapist and speak to them before you begin therapy.  Your evaluation of the therapist begins right then and there!  According to Ardito and Rabellino (2011),  the quality of the client–therapist alliance is a reliable predictor of positive therapeutic outcome independent of the variety of psychotherapy approaches and outcome measures.  It is important that you and the therapist fit well together, so start your evaluation right then and there.

Finding an In-Patient Treatment Facility for Sex Addiction
A qualified therapist who has experience with sex addiction would be able to provide you with a referral, even if you don’t become a client, to a good treatment facility for sex addiction if you would like to go to a residential treatment facility.

Or you could try to google “sex addiction treatment facility” or “sex addiction intensive outpatient program” and see what comes up.  You could also go to a 12-step meeting and speak to some of the other recovering members to see where they did their inpatient treatment and where they would recommend.  When it comes to inpatient treatment, it is likely you would need to travel to go to one.  Intensive outpatient programs are becoming more popular these days but still can be hard to find.  The International Institute of Trauma and Addiction Professionals (http://www.iitap.com) has a list of treatment partners that have intensive outpatient programs and inpatient programs, but that list does not list quite a few of the major players.  Do your research and ask around.  There are a lot of programs that are excellent but you need to know about them.

It is important you look at the reviews of the facility and call the facility ahead of time.  Some facilities pop up and would gladly take your money, but don’t always have a good reputation or provide the services they say they offer.  It would be important to know how long the facility has been in operation for and to look at what folks are saying about it as well.

No matter what treatment option is chosen, treatment of and recovery from sex addiction for the addict and their partner and children takes a LOT of time, energy, and resources and is hard work.  There is no easy fix for addiction treatment- it took a long time to get where people are when they finally seek treatment, it takes a long time to unravel that knot.  The good news is (though): treatment DOES help!